Tobacco use is the leading cause of preventable death and illness in the US. Despite its availability, the Guideline for evidence-based smoking cessation interventions is underutilized by healthcare professionals. The purpose of this proposal is to translate the Guideline into nursing practice by using an innovative web- based intervention, Helping Smokers Quit (HSQ). The HSQ includes a validated web-based educational program tailored for nurses working in acute care hospitals, a toolkit of printed materials, including the HSQ Pocket Guide for Nurses, web-resources in a special tab on the Tobacco Free Nurses website www.tobaccofreenurses.org, and technical support to the Directors of Nursing (DN). The control group (HSQ- m) will only receive the toolkit. The primary aims are to: 1) Evaluate the effectiveness of the HSQ in improving self-reported nursing performance on smoking cessation interventions with hospitalized patients 6-months after the intervention as compared to the HSQ-m group; 2) Determine the adoption and maintenance of changes in a) nurse performance on cessation interventions 12-months after the intervention; and b) hospital practices 24-months after the intervention in the HSQ as compared to the HSQ-m group; and 3) Determine the variables (nurse- and hospital-level) on the effectiveness of the HSQ and HSQ-m in nursing performance at 6- and 12- months after the intervention. Also, we will: 4) Examine improvement in hospital performance in smoking cessation (based on ratings by the Joint Commission, JC) on interventions offered to patients with the target diagnoses (heart attack, heart failure, and pneumonia), at 12- and 24-months post-intervention in the HSQ as compared to the HSQ-m group; and 5) Evaluate implementation (utilization and satisfaction) of the HSQ and HSQ-m. Six hundred (n = 300 HSQ and n = 300 HSQ-m) nurses from two states with high smoking prevalence (West Virginia, WV, Indiana, IN) and one with low prevalence (California, CA) are the focus of this program. Using an intervention-control, two-group, pre-post design, based upon the RE-AIM model, the HSQ will be delivered to nurses in 15 JC accredited hospitals in WV, IN, and CA (5 in each state). Nurses in 15 other hospitals (5 per state) will serve as controls (HSQ-m). We will partner with nurse experts and tobacco control consultants who will provide community support. The RX for Change(c) curriculum will be delivered via webcast. Data on self-reported nursing performance in smoking cessation will be collected via the web using a valid and reliable questionnaire. Publicly available data from the JC will be used to monitor changes in hospital performance. Interviews with the DNs 24-months after the intervention will identify maintenance of changes in hospitals. Regression models will evaluate effectiveness of the HSQ, adoption/ maintenance of changes in nursing performance; multiple linear regression will examine correlates of nurse performance. Content analysis will be used to evaluate interview responses. This project will provide information about translation of the Guideline to clinical practice and the link between a training program and changes in hospital performance. Statement Despite the availability of proven ways to help patients help stop smoking, the leading cause of preventable death and illness in the US, these interventions are not a routine part of nursing care. The purpose of this application is to translate smoking cessation interventions into clinical nursing practice using a web-based program in three states. Two of these states have smoking prevalence >25%, twice the 12% goal set by Healthy People 2010, and the rate in one state is the second lowest in the country. This project has potential to decrease smoking and improve health outcomes of Americans. [unreadable] [unreadable] [unreadable]